Surgical clip appliers

ABSTRACT

A surgical clip applier includes a housing, at least one handle, a channel assembly, a clip carrier, a wedge plate, a clip pusher bar, and a clip follower. The at least one handle is pivotably connected to the housing. The channel assembly extends distally from the housing. The clip carrier is disposed within the channel assembly and defines a channel and a plurality of windows. The wedge plate is reciprocally disposed within the channel assembly. The clip pusher bar is reciprocally positioned within the housing and the channel assembly. The clip follower is slidably disposed within the channel of the clip carrier and disposed proximally of a plurality of clips. The clip follower is configured and dimensioned to lockout the clip applier after a last clip of the plurality of clips has been expelled by the surgical clip applier.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a Continuation Application claiming the benefit of and priority to U.S. patent application Ser. No. 12/976,120, filed on Dec. 22, 2010, which claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 61/306,174, filed on Feb. 19, 2010, the entire contents of each of which are incorporated herein by reference.

The present application is also a Continuation-in-Part Application claiming the benefit of and priority to U.S. patent application Ser. No. 13/890,580, filed on May 9, 2013, which is a Divisional Application claiming the benefit of and priority to U.S. patent application Ser. No. 12/540,475, filed on Aug. 13, 2009 (now U.S. Pat. No. 8,465,502), which claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 61/091,467, filed on Aug. 25, 2008, the entire contents of each of which are incorporated herein by reference.

BACKGROUND

1. Technical Field

The present application relates to surgical instruments, and more particularly, to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures.

2. Discussion of Related Art

Surgical clip appliers are known in the art and have increased in popularity among surgeons by offering an alternative to conventional suturing of body tissues and vessels. Typical instruments are disclosed in U.S. Pat. No. 5,030,226 to Green et al. and U.S. Pat. No. 5,431,668 to Burbank III et al. These instruments generally provide a plurality of clips which are stored in the instrument and which are fed sequentially to the jaw mechanism at the distal end of the instrument upon opening and closing of the handles at the proximal end of the instrument. As the handles are closed, the jaws close to deform a clip positioned between the jaw members, and as the jaws are opened to release the deformed clip, a new clip is fed from the series to a position between the jaws. This process is repeated until all the clips in the series of clips have been applied.

Typically, the surgical clip applier is removed from a surgical site after the last clip has been applied to body tissue. Afterwards, the surgical clip applier is either replaced with a replacement surgical clip applier or the existing surgical clip applier is refilled with replacement surgical clips. However, in certain situations, when the same surgical clip applier is mistakenly used after the last clip has been applied, the jaw members of the surgical clip applier may unwantedly grasp body tissue at the surgical site. As a result, the body tissue may be damaged, which sometimes causes trauma to the patient.

The need therefore exists for a surgical clip applier that is configured to lock out the handles after the last clip has been applied.

SUMMARY

The present disclosure relates to surgical clip appliers having a plurality of clips for applying the clips to body tissues and vessels during surgical procedures.

According to an aspect of the present disclosure, a surgical clip applier is provided which includes a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a clip carrier disposed within the channel assembly and defining a channel and a plurality of windows therein; a plurality of clips slidably disposed within the channel of the clip carrier; a wedge plate reciprocally disposed within the channel assembly; and a clip pusher bar reciprocally positioned within the housing and the channel assembly. The pusher bar has a proximal end operatively connected to at least one handle and a distal end defining a pusher. The distal end of the pusher bar is configured for engagement with a distal-most clip of the plurality of clips. A clip follower is slidably disposed within the channel of the clip carrier and disposed proximally of the plurality of clips. The clip follower is configured and dimensioned to lockout the clip applier after a last clip of the plurality of clips has been expelled by the surgical clip applier.

The clip applier may further include a jaw assembly that has a pair of jaws extending from an end of the channel assembly, opposite the housing. The jaw assembly is adapted to accommodate a clip therein and is operable to effect formation of a clip in response to movement of the at least one handle. The pusher bar may be movable towards the jaws as the at least one handle is approximated in a first direction in order to move a distal-most clip between the jaws. The pusher bar may be configured and adapted to move towards the housing as the at least one handle is further approximated in the first direction to move the pusher behind a distal-most clip in the plurality of clips.

In embodiments, the clip follower may include a window formed in a body portion thereof. Upon the at least one handle being further actuated, the distal end of the pusher tip is disposed within the window of the clip follower. The clip follower may be disposed within a distal end of clip channel and a down force of at least one resilient tang of the clip carrier facilitates retaining the clip follower at the distal end of the clip channel.

In embodiments, upon the at least one handle being further actuated, the clip pusher engages a distal end of the window of the clip follower and distally urges the clip follower to move in between the jaws. The jaws are approximated toward one another and the clip follower is urged therebetween thereby preventing the jaws from closing. Upon the at least one handle being further actuated, a ratchet mechanism is partially engaged thereby locking the at least one handle at a position.

The clip follower may be configured to lock the at least one handle after a last clip of the plurality of clips has been expelled. Upon the at least one handle being released from an actuated position, the pusher bar returns to a proximal position and, at a substantially same time, the clip follower is advanced distally within the clip carrier. Upon a release of the at least one handle from an actuated position, the clip pusher retracts proximally to a proximal position.

In embodiments, the clip follower may define at least one notch along each side thereof. The at least one notch is configured to facilitate bending of the clip follower in a direction transverse to a plane defined by a body portion thereof. The clip follower may also be configured and adapted for selective engagement with the windows of the clip carrier and the apertures of the wedge plate. The clip follower may be configured and adapted to urge the plurality of clips, in a distal direction relative to the clip carrier, upon reciprocal movement of the wedge plate. The clip follower may be actuated by the reciprocating forward and backward motion of a wedge plate.

BRIEF DESCRIPTION OF THE DRAWINGS

The present clip applier will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which:

FIG. 1 is a perspective view of a surgical clip applier according to an embodiment of the present disclosure;

FIG. 2 is a rear, perspective view of the surgical clip applier of FIG. 1, shown with a shipping wedge in position;

FIG. 3 is an exploded perspective view of the surgical clip applier of FIGS. 1-2;

FIG. 4 is a top, perspective view of a clip follower of the surgical clip applier of FIGS. 1-3;

FIG. 4A is an exploded perspective view of a bell crank gear and accelerator rack assembly of the surgical clip applier of FIGS. 1-3;

FIG. 4B is a perspective view of the accelerator rack of the surgical clip applier of FIGS. 1-3;

FIG. 4C is a perspective view of the bell crank gear of the surgical clip applier of FIGS. 1-3;

FIG. 4D is a top, perspective view of a pivot arm of the surgical clip applier of FIGS. 1-3;

FIG. 4E is a bottom, perspective view of the pivot arm of FIG. 4D;

FIG. 5 is a longitudinal cross-sectional view of the surgical clip applier of FIGS. 1-3, illustrating the surgical clip applier in an unactuated condition;

FIG. 6 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 7 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 8 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 8A is a cross-sectional view of the surgical clip applier of FIGS. 1-3, as taken through 8A-8A of FIG. 8;

FIG. 9 is a top, perspective view of a distal end of a channel assembly of the surgical clip applier of FIGS. 1-3, with a cover removed therefrom;

FIG. 10 is a top, perspective view of a distal end of the channel assembly of FIG. 9, with the cover and the pusher bar removed therefrom;

FIG. 11 is a top, perspective view of a distal end of the channel assembly of FIG. 9, with the cover, the pusher bar and a clip carrier removed therefrom;

FIG. 12 is a top, perspective view of a distal end of the channel assembly of FIG. 9, with the cover, the pusher bar, the clip carrier, the surgical clips and the clip follower removed therefrom;

FIG. 13 is an enlarged view of the indicated area of detail of FIG. 12;

FIG. 14 is a top, perspective view of the surgical clip applier of FIGS. 1-3, illustrated with the upper housing half, the pusher bar and a wedge plate removed therefrom;

FIG. 15 is a top, perspective view of a distal end of the channel assembly of FIG. 9, with the cover, the pusher bar, the clip carrier, the surgical clips, the clip follower and the wedge plate removed therefrom;

FIG. 16 is a longitudinal, cross-sectional view of the distal end of the channel assembly illustrating the surgical clip applier of FIGS. 1-3 in a locked-out condition following firing of the last surgical clip therefrom;

FIG. 17 is a top, perspective view of another embodiment of a clip follower, according to the present disclosure, for use with the surgical clip applier of FIGS. 1-16;

FIG. 18 is a top, perspective view of the distal end of a channel assembly of the surgical clip applier of FIGS. 1-16, illustrating a pair of retainer tangs retaining a last surgical clip;

FIG. 19 is a top, perspective view of the distal end of the channel assembly of the surgical clip applier of FIGS. 1-16, illustrating the clip follower of FIG. 17 at a distal position in the channel assembly;

FIG. 20 is a top, perspective view of the distal end of the channel assembly of the surgical clip applier of FIGS. 1-16, illustrating with the clip follower disposed and/or advanced between a pair of jaw members;

FIG. 21 is a top, perspective view of the distal end of the channel assembly of the surgical clip applier of FIGS. 1-16, illustrating the pusher bar being retracted in a proximal direction; and

FIG. 22 is a top, perspective view of a clip follower of FIG. 18 according to another embodiment of the present disclosure.

DETAILED DESCRIPTION

Embodiments of surgical clip appliers in accordance with the present disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical structural elements. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further away from the user.

FIGS. 1-5 illustrate a surgical clip applier in accordance with an embodiment of the present disclosure and is generally designated as 100. Reference may be made to U.S. Pat. No. 8,465,502, filed on Aug. 13, 2009, entitled “Surgical Clip Applier” and U.S. Pat. No. 8,056,565, filed on Aug. 11, 2009, entitled “Surgical Clip Applier and Method of Assembly,” the entire contents of each of which being incorporated herein by reference, for a detailed discussion of the structure, operation, and method of assembly of surgical clip applier 100.

Briefly, surgical clip applier 100 is a surgical instrument including a handle assembly 102 including a housing 104 having an upper housing half 104 a and lower housing half 104 b. Handle assembly 102 further includes a pair of handles 106 pivotably secured to housing 104 and extending outwardly therefrom. A channel assembly 108 is fixedly secured to housing 104 and extends outwardly therefrom, terminating in a jaw assembly 110.

As seen in FIGS. 1-3, housing halves 104 a and 104 b of clip applier 100 fit together by snap fit engagement with one another. Housing 104 defines a window 104 c formed in lower housing half 104 b for supporting and displaying a counter mechanism 190. Housing 104 is formed of a suitable plastic material.

As seen in FIG. 3, handles 106 are secured to housing 104 by handle pivot posts 104 d extending from lower housing half 104 b and into respective apertures 106 a formed in handles 106. Handle assembly 102 includes a link member 122 pivotally connected to each handle 106 at a pivot point 106 b formed in a respective handle 106. A distal end 122 a of each link member 122 is pivotally connected to a pivot point 140 a formed in a drive channel 140 via a drive pin 124. Each end of drive pin 124 is slidably received in an elongate channel 104 e formed in a respective upper and lower housing half 104 a, 104 b. In use, as handles 106 are squeezed, link members 122 push drive channel 140 distally via drive pin 124.

Channel assembly 108 includes a channel or cartridge cover 130 and an outer or lower channel 132 each having a proximal end retained in housing assembly 102, between upper and lower housing halves 104 a, 104 b. Cartridge cover 130 includes at least one retention element 130 a configured and adapted to selectively engage, in a snap-fit engagement, a complementary or corresponding retention element 132 a provided on outer channel 132.

As seen in FIGS. 3 and 6-9, clip applier 100 includes a clip pusher bar 160 slidably disposed beneath cartridge cover 130. Pusher bar 160 includes a distal end 160 a defining a pusher 160 c configured and adapted to selectively engage/move a distal-most clip “C1” stored in surgical clip applier 100. Pusher bar 160 further includes a proximal end 160 b defining a proximal window 160 d therein for slidably receiving drive pin 124 therein. Pusher bar 160 further defines a distal window 160 e therein for operative engagement with a stabilizer 162. Pusher bar 160 also includes a fin 160 f projecting from a side edge thereof and located in relative close proximity to proximal window 160 d.

Clip applier 100 further includes a stabilizer 162 configured to overlie and engage pusher bar 160. Stabilizer 162 includes a distal tab 162 a configured to engage distal window 160 e of pusher bar 160, an elongate window 162 b defined therein at a location to substantially overlie and be in registration with proximal window 160 d formed in pusher bar 160. For a more detailed discussion of stabilizer 162, please refer to commonly owned U.S. Pat. No. 8,465,502 and U.S. Pat. No. 8,056,565, the entire contents of each of which incorporated by reference above.

As seen in FIGS. 3 and 4A-4C, clip applier 100 further includes a motion multiplier system having a bell crank gear 154 pivotally supported in housing 104 and an accelerator housing 156 slidably supported in housing 104. Bell crank gear 154 includes a pivot pin 154 a configured for pivotable connection to housing 104, a disk-like body 154 b supported on pivot pin 154 a, an arm 154 c extending radially from disk-like body 154 b, and a spur gear 154 d supported on pivot pin 154 a or integrally formed therewith and located adjacent disk-like body 154 b. Bell crank gear 154 defines a longitudinally oriented slot 154 f formed in arm 154 c. Spur gear 154 d of bell crank 154 defines a plurality of gear teeth 154 g formed in a side edge thereof and may be a sector gear as best shown in FIG. 4C. For a more detailed discussion of bell crank gear 154, please refer to commonly owned U.S. Pat. No. 8,465,502 and U.S. Pat. No. 8,056,565, the entire contents of each of which incorporated by reference above.

With continued reference to FIGS. 3 and 4A-4C, accelerator rack 156 of motion multiplier system includes a base wall 156 a defining an elongate, longitudinally extending slot 156 b formed therein, for slidable receipt of pivot pin 154 a of bell crank gear 154. Accelerator rack 156 includes a side wall 156 c projecting in opposite directions from a side edge of base wall 156 a, and a gear rack 156 d formed in side wall 156 c and in registration or alignment with slot 156 b of base wall 156 a. Gear rack 156 d is configured for engagement with gear teeth 154 g of spur gear 154 d of bell crank gear 154.

Clip applier 100 further includes a biasing member 158 interconnecting accelerator rack 156 and drive channel 140.

Clip applier 100 further includes a clip carrier 170 disposed within channel assembly 108 and beneath pusher bar 160. Clip carrier 170 is generally a box-like structure having an upper wall 170 a, a pair of side walls 170 b (FIG. 8A) and a lower wall 170 c (FIG. 8A) defining a channel 170 d (FIG. 8A) therethrough. Clip carrier 170 includes a plurality of spaced apart windows 172 formed in upper wall 170 a and extending longitudinally along a length thereof. Clip carrier 170 includes an elongate window 170 e (FIG. 8A) formed in lower wall 170 c (FIG. 8A) and extending longitudinally along a length thereof.

As seen in FIGS. 3 and 10, a stack of surgical clips “C” is loaded and/or retained within channel 170 d of clip carrier 170 in a manner so as to slide therewithin and/or therealong. Channel 170 d is configured and dimensioned to slidably retain a stack or plurality of surgical clips “C” in tip-to-tail fashion therewithin.

As seen in FIGS. 3, 9, and 10, a distal end of clip carrier 170 includes a pair of spaced apart, resilient tangs 171. Tangs 171 are configured and adapted to selectively engage a backspan of a distal-most surgical clip “C1” of the stack of surgical clips “C” retained within carrier 170.

As seen in FIGS. 3, 4, 7, and 11, clip applier 100 further includes a clip follower 174 slidably disposed within channel 170 d of clip carrier 170. As will be discussed in greater detail below, clip follower 174 is positioned behind the stack of surgical clips “C” and is provided to urge the stack of clips “C” forward during an actuation of clip applier 100. As will be described in greater detail below, clip follower 174 is actuated by the reciprocating forward and backward motion of wedge plate 180.

As seen in FIGS. 4 and 7, clip follower 174 includes body portion 174 a defining a plane, a distal tab 175 extending substantially upwardly and rearwardly from body portion 174 a, and a proximal tab 176 extending substantially downwardly and rearwardly from body portion 174 a. Distal tab 175 includes a distal portion 175 a extending downwardly below the plane defined by body portion 174 a and a proximal portion 175 b extending upwardly above the plane defined by body portion 174 a.

Proximal portion 175 b of distal tab 175 is configured and dimensioned to selectively engage windows 172 formed in upper wall 170 a of clip carrier 170. In use, engagement of proximal portion 175 b of distal tab 175 of clip follower 174 in a window 172 formed in upper wall 170 a of clip carrier 170 prevents clip follower from traveling or moving in a proximal direction.

Proximal tab 176 is configured and dimensioned to selectively engage windows 180 b formed in wedge plate 180. In use, engagement of proximal tab 176 of clip follower 174 in a window 180 b formed in wedge plate 180 allows for clip follower 174 to be advanced or moved distally upon a distal movement of wedge plate 180.

As seen in FIGS. 3, 7, 8, 12, and 13, clip applier 100 further includes a wedge plate 180 slidably disposed within handle assembly 102 and channel assembly 108. Wedge plate 180 is positioned or disposed below clip carrier 170. Wedge plate 180 includes a substantially tapered distal end 180 a for selective operative interposition between jaws 120. Wedge plate 180 defines a plurality of spaced apart windows or apertures 180 b extending longitudinally along a length thereof and formed in a raised section thereof, a distal window or aperture 180 c located distal of apertures 180 b, and a proximal-most transversely oriented slot 180 d located proximal of aperture 180 c.

As seen in FIGS. 3, 8, 12, and 13, clip applier 100 includes a distal lockout 178 supported by cartridge cover 130. Distal lockout 178 includes a tail or tab 178 a extending substantially rearwardly and downwardly and being configured and dimensioned for receipt in distal window or aperture 180 c of wedge plate 180.

As seen in FIGS. 3, 4D, 4E, 6, and 14, clip applier 100 includes a wedge plate motion reversing mechanism, in the form of a pivot arm 179, pivotally supported in lower housing half 104 b of housing 104 for transmitting the translation of drive channel 140 to a reverse translation of wedge plate 180.

In use, as drive channel 140 is moved distally, after a dwell period (i.e., the length of the longitudinally extending distal portion of slot 140 g of drive channel 140), second stem or finger 179 c is moved in a distal direction, rotating pivot arm 179 and thereby moving first stem or finger 179 b in a second direction. As first stem or finger 179 b is moved in the second direction, first stem or finger 179 b pulls wedge plate 180 out from between jaws 120 urges against as well as urges or pushes proximally against fin 160 f of pusher 160 to move pusher 160 in a proximal direction so that pusher bar 160 c thereof is removed from between jaws 120, and vice-versa. As wedge plate 180 is moved in a distal direction, as seen n FIG. 13, distal end 180 a of wedge plate 180 cams against an inner surface of jaws 120 to thereby maintain jaws 120 spaced apart from one another.

As seen in FIGS. 3, 6-8, 14, and 15, clip applier 100 includes a drive channel 140 reciprocally supported in and extending between housing 104 of handle assembly 102 and channel assembly 108. A proximal end of drive channel 140 is supported between upper and lower housing halves 104 a, 104 b of housing 104 and a distal end of drive channel 140 is supported between cartridge cover 130 and outer channel 132 of channel assembly 108, at a location below wedge plate 180.

A distal end of drive channel 140 is a substantially U-shaped channel including a pair of spaced apart side walls 140 b extending from a backspan 140 c thereof, in a direction away from outer channel 132 and toward cartridge cover 130. Drive channel 140 further defines a drive pin recess 140 a formed in backspan 140 c for pivotally receiving drive pin 124 therethrough. Drive channel 140 further defines a rib 140 e projecting from backspan 140 c at a location distal of drive pin recess 140 a. Drive channel 140 further defines a reciprocation limiting slot 140 f formed in backspan 140 c at a location distal of slot 140 e.

As seen in FIGS. 3, 8-12, and 15, clip applier 100 includes a drive channel strap 143 secured to drive channel 140. Strap 143 is secured to uprights 140 b of drive channel 140 so as to extend transversely thereacross. Strap 143 is secured to drive channel 140 at a location distal of reciprocation limiting slot 140 f. Strap 143 is secured to drive channel 140 such that wedge plate 180 extends beneath strap 143 and above jaws 120.

As seen in FIGS. 3 and 6, clip applier 100 further includes an audible/tactile indicator 148 connected to drive channel 140 via drive pin 124. Indicator 148 includes a resilient finger 148 a and a pair of bosses 148 b. In use, as clip applier 100 is actuated and drive channel 140 is reciprocated, first resilient finger 148 a of indicator 148 interacts with corresponding complementary structure or ledge (not explicitly shown) provided in clip applier 100 to create an audible and/or a tactile feedback to the user. Bosses 148 b of indicator 148 ride within channel 104 e formed in upper housing half 104 a and provide support to indicator 148 to prevent indicator 148 from rotating.

As seen in FIGS. 3, 6, and 14, clip applier 100 further includes a biasing member 146, in the form of a tension spring, operatively secured to and between a proximal end of drive channel 140 and housing 104, tending to maintain drive channel 140 in a retracted or proximal-most position. Biasing member 146 functions to retract or facilitate retraction of drive channel 140 following formation of a clip “C” positioned between jaws 120.

As seen in FIGS. 3 and 14, a proximal end of drive channel 140 includes a ratchet rack member 141 secured to drive pin 124 and movable with drive channel 140. Ratchet rack member 141 is configured and adapted to engage with a ratchet pawl 142 supported in housing 104. Rack member 141 and pawl 142 define a ratchet mechanism 144. In use, as drive channel 140 is moved axially, rack member 141 is also moved. Rack member 141 defines a series of rack teeth 141 a having a length which allows pawl 142 to reverse and advance back over rack member 141 when rack member 141 changes between proximal and distal movement as drive channel 140 reaches a proximal-most or distal-most position.

Pawl 142 is pivotally connected to lower housing half 104 b by a pawl pin 147 at a location wherein pawl 142 is in substantial operative engagement with rack member 141. Pawl 142 is engageable with rack member 141 to restrict longitudinal movement of rack member 141 and, in turn, drive channel 140. Ratchet mechanism 144 further includes a pawl spring 145 configured and positioned to bias pawl 142 into operative engagement with rack member 141. Pawl spring 145 functions to maintain the teeth of pawl 142 in engagement with the teeth 141 a of rack member 141, as well as to maintain pawl 142 in a rotated or canted position.

As seen in FIGS. 1-3, 8-13, and 15, clip applier 100 includes a pair of jaws 120 mounted on or at a distal end of channel assembly 108 and actuatable by handles 106 of handle assembly 102. Jaws 120 are formed of a suitable biocompatible material such as, for example, stainless steel or titanium.

Jaws 120 are mounted in a distal end of drive channel 140 via a rivet 122 or the like extending through reciprocation limiting slot 140 f of drive channel 140 such that jaws 120 are longitudinally stationary relative to outer channel 132 and drive channel 140. As seen in FIGS. 9, 10, 13, and 15, jaws 120 define a channel 120 a therebetween for receipt of a surgical clip “C1” therein.

As seen in FIGS. 1-3, and 6, clip applier 100 further includes a counter mechanism 190 supported in housing 104 of handle assembly 102. Counter mechanism 190 includes a display 192, a processor 194, and an energy source 198 in the form of a battery or the like. Display 192 is a liquid crystal display that displays one or more operating parameters of clip applier 100 to the surgeon. The operating parameter displayed may be an amount or number of remaining clips, a number of clips that have been used, a position parameter, a surgical time of usage, or any other parameter of the procedure. For a more detailed discussion of counter mechanism 190, please refer to commonly owned U.S. Pat. No. 8,465,502 and U.S. Pat. No. 8,056,565, the entire contents of each of which incorporated by reference above.

As seen in FIG. 2, clip applier 100 includes a shipping wedge 200 supported on housing 104 and interposed between handles 106. Shipping wedge 200 functions to maintain handles 106 spaced apart or un-squeezed during a shipment and/or storage of clip applier 100. Shipping wedge 200 is connected to tab 192 a of counter mechanism 190, such that in order for an end user to use clip applier 100, the end user must remove shipping wedge 200 thereby also removing tab 192 a to activate counter mechanism 190. For a more detailed discussion of shipping wedge 200, please refer to commonly owned U.S. Pat. No. 8,465,502 and U.S. Pat. No. 8,056,565, the entire contents of each of which incorporated by reference above.

Turning now to FIG. 16, a distal end of clip applier 100 is illustrated following a complete stroke or squeezing of handles 106 and after a final clip has been expelled therefrom. Following firing of the last clip, as seen in FIG. 16, proximal tab 176 of clip follower is disposed within a distal-most aperture or window of apertures 180 b of wedge plate 180. In this manner, as wedge plate 180 is moved distally following a firing of a clip, in the manner described above, clip follower 174 is also moved distally. Accordingly, as clip follower 174 is moved distally, distal tab 175 thereof is moved distal of a distal-most window of windows 172 of clip carrier 170. In this manner, proximal portion 175 b of distal tab 175 engages against an inner surface of a top wall of clip carrier 170 and is cammed or urged downwardly.

As proximal portion 175 b of distal tab 175 is cammed or urged downwardly, distal portion 175 a of distal tab 175 engages against an upper surface of tab 178 a of lockout 178 and cams or urges tab 178 a of lockout 178 downwardly, across a path of strap 143, supported on drive channel 140, and into distal window 180 c of wedge plate 180. In this manner, if drive channel 140 is advanced distally, in the manner described above, strap 143 will abut against tab 178 a of lockout 178 and prevent or block strap 143 and, in turn, drive channel 140 from moving distally. At this stage, pawl 142 is located in a dwell, distal of rack 140 d, and handles 106 are arranged in a fully opened position and are thus not capable of being opened any further. In this configuration, clip applier is locked-out and can no longer be used.

Referring now to FIGS. 17-22, a surgical clip applier, in accordance with an embodiment of the present disclosure, is generally designated as 300. Surgical clip applier 300 is substantially identical to surgical clip applier 100 and thus will only be discussed in detail herein to the extent necessary to identify differences in construction and operation thereof

As seen in FIGS. 18-21, clip applier 300 includes a clip follower 374 slidably disposed within channel 370 d of clip carrier 370. Clip follower 374 is positioned behind the stack of surgical clips “C” and is provided to urge the stack of clips “C” forward during an actuation of clip applier 300, in a manner similar to clip follower 174 described above. Clip follower 374 is actuated by the reciprocating forward and backward motion of wedge plate (not shown), as shown in FIGS. 3, 5, 6, and 8-10 with regard to clip follower 174. In this embodiment, as will be described further below, clip follower 374 is also configured to lock clip applier 300 after a last clip “C_(L)” has been expelled.

As seen in FIGS. 17 and 22, clip follower 374 includes body portion 374 a defining a plane, a distal tab 375 extending substantially upwardly and rearwardly from body portion 374 a, a proximal tab 376 extending substantially downwardly and rearwardly from body portion 374 a, and a slot or window 377 formed on a distal portion 374 b of body portion 374 a. Distal tab 375 includes a distal portion 375 a extending downwardly below the plane defined by body portion 374 a and a proximal portion 375 b extending upwardly above the plane defined by body portion 374 a.

Proximal portion 375 b of distal tab 375 is configured and dimensioned to selectively engage windows formed in an upper wall of clip carrier 370, as discussed above with regard to clip carrier 170. In use, engagement of proximal portion 375 b of distal tab 375 of clip follower 374 in a window formed in upper wall of clip carrier 370 prevents clip follower from traveling or moving in a proximal direction.

Proximal tab 376 is configured and dimensioned to selectively engage windows formed in a wedge plate (not shown). In use, engagement of proximal tab 376 of clip follower 374 in a window formed in the wedge plate allows for clip follower 374 to be advanced or moved distally upon a distal movement of the wedge plate, as discussed above with regard to wedge plate 180.

As discussed above, clip follower 374 is configured and dimensioned to lockout clip applier 300 after a last clip “C_(L)” has been expelled. That is, when surgical clip applier 300 has one last clip “C_(L)” left in the clip channel 370, the follower 374 abuts the last clip “C_(L)” and the distal end 360 c of pusher bar 360 advances the last clip “C_(L)” into the jaws 320 when the handles 306 are selectively squeezed.

In this configuration, when the handles (not shown) are selectively squeezed (i.e., actuated) the last clip “C_(L)” is expelled from the clip applier 300 to the body tissue. Afterwards, the handles are released and the pusher bar 360 returns to a proximal “home” position, as described above, with regard to clip applier 100. At substantially the same time, the clip follower 374 is advanced distally within the clip carrier 370 by the wedge plate, as described above. In this configuration, the distal end 360 c of pusher tip 360 is disposed within window 377 of clip follower 374. In this configuration of clip applier 300, clip follower 374 is disposed within the distal end of clip channel 370. It is contemplated that a down force of resilient tangs 371 may also facilitate retention of clip follower 374 at the distal end of the clip channel 370.

When the handles are squeezed for a second time, distal end 360 c of clip pusher 360 engages a distal end of window 377 of clip follower 374 and distally urges (i.e., moves) at least a distal end of clip follower 374 in between jaws 320. At substantially the same time, while the handles are squeezed the strap 343 and drive channel 340 engage an outer surface (i.e., side surface) of jaws 320.

As seen in FIG. 20, as drive channel 340 is moved distally, a distal edge of drive channel 340 and/or drive channel strap 343 engages against camming surfaces 320 b of jaws 320. In this manner, jaws 320 are approximated toward one another and frictionally contain clip follower 374 therebetween. Since drive channel strap 343 is fixed to drive channel 340 and moves therewith, drive channel strap 343 functions to cap drive channel 340 so as to maintain jaws 320 within drive channel 340 during the approximation of jaws 320 and to maintain the wedge plate within drive channel 340 during operation of clip applier 300. Then, when the handles are released, clip pusher 360 retracts proximally to the proximal “home” position, as described above.

FIG. 22 illustrates the clip follower 374 in a locked-out position when the handles are squeezed for a third time. In this configuration, the ratchet mechanism 144 (as shown in FIG. 14) engages to a certain point and the handles stop substantially half way through a stroke thereof and are thus locked in place. As so configured, jaws 320 are prevented from re-closing, since clip follower 374 is disposed between jaws 320. In this configuration, clip applier 300 is in a locked-out configuration.

In one embodiment, as seen in FIG. 22, one or more notches 378 are formed along a side edge of clip follower 374. Notches 378 facilitate a bending of clip follower 374, in a direction transverse to the plane of body portion 374 a, when clip follower 374 is wedged or cammed between jaws 320. In this manner, clip follower 374 may more easily conform to the bend or contour of jaws 320, as described above. In another embodiment, the clip follower may be manufactured to have a distinguishable color (e.g., red, orange, yellow, green, blue, etc.) from the other components of the clip applier 300. In this manner, the colored clip follower 374 may indicate to the user that clip applier 300 is in a locked-out state.

It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure. 

1. (canceled)
 2. A surgical clip applier for applying surgical clips to body tissue, the surgical clip applier comprising: a housing; at least one handle pivotably connected to the housing; a channel assembly extending distally from the housing; a clip carrier disposed within the channel assembly and defining a channel and a plurality of windows therein; a plurality of clips slidably disposed within the channel of the clip carrier; a wedge plate reciprocally disposed within the channel assembly, the wedge plate being operatively connected to the at least one handle and including a plurality of apertures formed along a length thereof; a clip pusher bar reciprocally positioned within the housing and the channel assembly, the pusher bar having a proximal end operatively connected to the at least one handle and a distal end defining a pusher, wherein the distal end of the clip pusher bar is configured for engagement with a distal-most clip of the plurality of clips; and a clip follower slidably disposed within the channel of the clip carrier and disposed proximally of the plurality of clips, the clip follower being configured for selective engagement with the plurality of windows of the clip carrier and the plurality of apertures of the wedge plate, the clip follower being configured to urge the plurality of clips in a distal direction relative to the clip carrier upon reciprocal movement of the wedge plate, wherein the clip follower is configured and dimensioned to lockout the clip applier after a last clip of the plurality of clips has been expelled by the surgical clip applier.
 3. The surgical clip applier according to claim 2, further comprising: a jaw assembly including a pair of jaws extending from an end of the channel assembly, opposite the housing, the jaw assembly adapted to accommodate a clip therein and being operable to effect formation of a clip in response to movement of the at least one handle.
 4. The surgical clip applier according to claim 3, wherein the pusher bar is movable towards the jaws as the at least one handle is approximated in a first direction in order to move a distal-most clip between the jaws, and the pusher bar being configured and adapted to move towards the housing as the at least one handle is further approximated in the first direction to move the pusher behind a distal-most clip in the plurality of clips.
 5. The surgical clip applier according to claim 3, wherein the clip follower further includes a window formed in a body portion thereof.
 6. The surgical clip applier according to claim 5, wherein upon the at least one handle being actuated after the last clip of the plurality of clips has been expelled, a distal end of the pusher is disposed within the window of the clip follower.
 7. The surgical clip applier according to claim 5, wherein the clip follower is disposed within a distal end of the clip channel and a down force of at least one resilient tang of the clip carrier facilitates retaining the clip follower at the distal end of the clip channel.
 8. The surgical clip applier according to claim 5, wherein upon the at least one handle being further actuated, the pusher engages a distal end of the window of the clip follower and distally urges the clip follower to move in between the pair of jaws.
 9. The surgical clip applier according to claim 8, wherein the pair of jaws are approximated toward one another and the clip follower is urged therebetween thereby preventing the pair of jaws from closing.
 10. The surgical clip applier according to claim 9, wherein upon the at least one handle being further actuated, a ratchet mechanism is partially engaged thereby locking the at least one handle at a position.
 11. The surgical clip applier according to claim 2, wherein the clip follower is configured to lock the at least one handle after a last clip of the plurality of clips has been expelled.
 12. The surgical clip applier according to claim 2, wherein upon the at least one handle being released from an actuated position, the clip pusher bar returns to a proximal position and the clip follower is advanced distally within the clip carrier.
 13. The surgical clip applier according to claim 2, wherein upon a release of the at least one handle from an actuated position, the clip pusher bar retracts proximally to a proximal position.
 14. The surgical clip applier according to claim 2, wherein the clip follower defines at least one notch along each side thereof, the at least one notch being configured to facilitate bending of the clip follower in a direction transverse to a plane defined by a body portion thereof.
 15. The surgical clip applier according to claim 2, wherein the clip follower is actuated by reciprocating forward and backward motion of the wedge plate. 